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General

Study Overview

Title:

EVALUATION OF NEXT GENERATION NUTRITION PROGRAMME IN TANZANIA

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-58f6eea074cba

Initial Registration Date:

04/18/2017

Last Update Date:

03/15/2017

Study Status:

Ongoing

Location(s):

Tanzania

Abstract:

This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a controlled before after evaluation implemented in Simiyu and Ruvuma regions, with Nzega, Uyui, Ruangwa and Lindi being the control areas. The project aims to test the hypothesis that targeted bundle of interventions spanning the 1,000 days period (increased knowledge, attitudes and practices for healthy pregnancy and infant feeding practices and treatment of severe acute malnutrition (SAM) cases) will reduce stunting in children under-two years. We are also exploring community norms contributing to poor maternal, child health and nutrition outcomes. To make it scalable, the study will assess quality of data collected and perform costs analysis.

Registration Citation:

Elisaria, E. and Geubbels, E., EVALUATION OF NEXT GENERATION NUTRITION PROGRAMME IN TANZANIA. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie110

Categories:

Health, Nutrition, and Population

Additional Keywords:

Nutrition, Integrated intervention

Secondary ID Number(s):

NIMR/HQIR 8 al\l ol. D{12208

Principal Investigator(s)

Name of First PI:

Dr Ester Elisaria

Affiliation:

Ifakara health institute

Name of Second PI:

Eveline Geubbels

Affiliation:

Ifakara Health Institute

Study Sponsor

Name:

Children's Investment Fund Foundation (CIFF)

Study Sponsor Location:

United Kingdom

Research Partner

Name of Partner Institution:

Type of Organization:

Location:

Intervention

Intervention Overview

Intervention:

The intervention has twofold aims: 1. To deliver a targeted package of interventions at scale through the health system to prevent stunting and 2. To show that integrating activities for chronic and severe acute malnutrition will lead to better outcomes at lower costs. Objectives The programme will demonstrate how to integrate the delivery of services to prevent stunting and treat severe acute malnutrition, following the same pregnant mothers and children under five across the critical points in the lifecycle and continuum of care. There will be a special focus on children under 2 to prevent stunting. The specific objectives are: 1. Reduce stunting prevalence and increase the number of children successfully treated for SAM (Severe Acute Malnutrition); 2. Increase knowledge, attitudes and practices on birth preparedness, maternal nutrition, and appropriate infant and young child feeding practices; 3. Strengthen capacity of the sub-national level health service to deliver integrated nutrition services, which are underpinned by quality data. To ensure sustainability, the program uses both government and behaviour change pathways. The intervention will be delivered by the Ta

Theory of Change:

Multiple Treatment Arms Evaluated?

No

Implementing Agency

Name of Organization:

Doctors with Africa CUAMM

Type of Organization:

NGO (International)

Program Funder

Name of Organization:

Children's Investment Fund Foundation (CIFF)

Type of Organization:

NGO (International)

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

09/01/2016

End Date:

12/01/2019

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Difference in difference/fixed effects

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

We propose to use a controlled before-after design (CBA) for the evaluation of KAP outcomes and nutritional impacts. The design will measure the difference in the baseline-to-end-line change of key maternal and child KAP and nutrition indicators between intervention districts and a counterfactual of 4 districts matched on key indicators. For the evaluation of process quality and scalability we propose to use a combination of checklists, provider-patient observation, clinical vignettes document review and in-depth interviews (IDIs). At mid-term we will assess intermediate program results using a KAP survey on key indicators. For the Data Quality Assessment (DQA), we will do a rapid DQA in the first year to assess data management bottlenecks and do a full DQA at midterm and end-line using an adapted standardized DQA assessment tool. For the cost evaluation a design is proposed using a health system perspective, including financial and economic costs related to program delivery, but excluding direct and indirect patient costs. This because decisions about programme scale-up in Tanzania tend to be based on costs to the health system, less so based on cost from a societal perspective.

Outcomes (Endpoints):

The primary outcome for this study: Reduced prevalence of stunting in children under two, wasting in children under five and and Dietary diversity for the child aged 6–23 month. Secondary outcomes includes; improved uptake of high-impact nutrition interventions and behaviours across the lifecycle and improved quality of the routine monitoring data, particularly data collected at health facilities.

Unit of Analysis:

Mothers having children under 2 by the date of data collection (for women outcomes) and children under the age of 5 years (for child nutrition outcomes)

Hypotheses:

The project aims to test the hypothesis that targeted bundle of interventions spanning the 1,000 days period (increased knowledge, attitudes and practices for healthy pregnancy and infant feeding practices and treatment of severe acute malnutrition (SAM) cases) will reduce stunting in children under-two years. We are also exploring community norms contributing to poor maternal, child health and nutrition outcomes. To make it scalable, the study will assess quality of data collected and perform costs analysis

Unit of Intervention or Assignment:

Pregnant and lactating women, children under 2 and children and 5 years within the intervention regions.

Number of Clusters in Sample:

56 clusters are expected 28 from each arm of the study

Number of Individuals in Sample:

840 households were required in intervention districts and 1680 households in control districts for each round of the study

Size of Treatment, Control, or Comparison Subsamples:

30 households will be visited from each intervention cluster and 60 households from each of the selected control cluster

Supplementary Files

Analysis Plan:

Other Documents:

: CIFF NIMR CERTIFICATE.pdf

Data

Outcomes Data

Description:

The project will conduct three rounds of surveys (baseline, midterm and end-line). Qualitative survey will be conducted to capture community norms at baseline only. Household survey will be conducted at each round to capture knowledge, attitudes and practices related to healthy pregnancy and feeding practices. Child and mothers anthropometric measurement will be taken and baseline and end-line surveys only. Combination of checklists, provider-patient observation, clinical vignettes document rev

Data Already Collected?

Yes

Data Previously Used?

No

Data Access:

Not restricted - access with no requirements or minimal requirements (e.g. web registration)

Data Obtained by the Study Researchers?

Yes

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

Yes

Study Materials

Upload Study Materials:

Baseline report: TzNextGeneration_Quali_Quant_Baseline_Report_2016.pdf

Registration Category

Registration Category:

Non-Prospective, Category 4: Data for measuring impacts have been obtained/collected by the research team and analysis for this evaluation has started

Completion

Completion Overview

Intervention Completion Date:

Data Collection Completion Date:

Unit of Analysis:

Clusters in Final Sample:

Total Observations in Final Sample:

Size of Treatment, Control, or Comparison Subsamples:

Findings

Preliminary Report:

Preliminary Report URL:

Summary of Findings:

Paper:

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

Survey Instrument Links or Contact:

Program Files:

Program Files Links or Contact:

External Link:

External Link Description:

Description of Changes:

Study Stopped

Date:

Reason: